Medicare: Home Health Utilization Expands While Program Controls Deteriorate
HEHS-96-16
Published: Mar 27, 1996. Publicly Released: Apr 03, 1996.
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Highlights
Pursuant to a congressional request, GAO examined the growth in the use of Medicare home health benefits, focusing on the: (1) changes in the home health industry; (2) composition of Medicare home health users; (3) differences in utilization of home health benefits across geographic areas; (4) incentives to overuse Medicare home health benefits; and (5) effectiveness of payment controls in preventing payment for services not covered by Medicare.
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| Congress may wish to consider whether the Medicare home health benefit should continue to become more of a long-term care benefit or if it should be limited primarily to a posthospital acute care benefit. |
Closed – Implemented
|
The Balanced Budget Act of 1997 included a number of provisions designed to control Medicare home health expenditures, including a requirement that HCFA study the criteria that should be applied in the determination of whether a beneficiary is homebound. The HCFA report did not yield any new options for clarifying the homebound determinations. |
| Congress may wish to consider providing additional resources so that controls against abuse of the home health benefit can be better enforced. |
Closed – Implemented
|
The Health Insurance Portability and Accountability Act of 1996 increased funding for Medicare program integrity activities beginning in fiscal year 1997. Since HIPAA, additional funding has been allotted to home health care. Therefore, the intent of this recommendation is being met. |
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BeneficiariesClaims processingHealth care cost controlHealth resources utilizationHome health care servicesInternal controlsLong-term careMedical expense claimsMedical services ratesMedicareHealth care fraud